As Canadians get older, so do those inside our prisons. And a significant proportion of the overall prison population is serving life or indeterminate sentences, a result, some observers argue, of the federal government’s tough-on-crime stance.

Many are dying in custody.

According to a mortality review done late last year by the office of prisoners’ ombudsman Howard Sapers, fully two-thirds of all deaths (355 of 536) from the years 2003 to 2013 were a result of natural causes, on average about 35 a year.

Of those 35 who die, the average age is 62. That’s also the average age for the 60 to 80 offenders who die while out on parole.

Contrast that to the fact that life expectancy for the average Canadian male is about 79 years, and for women 83.

For offenders, cancer was the leading cause of death (42 per cent) followed by cardiovascular disease (20 per cent), according to a statistical report from Correctional Service Canada.

In his recent review of the natural deaths of inmates in Correctional Service Canada’s custody, Sapers says more inmates are succumbing to chronic diseases in prison, often because the proper treatment and diagnostic services aren’t in place.

His office has brought forward examples to Correctional Service Canada (CSC) from reviews of individual inmates’ deaths, and the examples raised “serious concerns about the access, quality and timeliness’’ of diagnostic services provided in prison, which “did not seem to match the equivalent standard of care provided in community hospital settings.’’

Sapers says federal penitentiaries were originally designed and built for younger inmates, not those with limited mobility and other impairments.

A typical prison wasn’t built to accommodate wheelchairs, walkers or hospital beds, and prison routines aren’t designed for people who are hard of hearing or visually impaired. Even getting to and using a telephone can be difficult for an older offender or one that suffers from hearing loss, he says.

A growing proportion of physically vulnerable older inmates is being housed in “crowded, inaccessible and overextended facilities,” Sapers has noted, and this can lead to significant safety, health-care and security concerns for aging prisoners. Twenty per cent of federal inmates are double-bunked.

“Older offenders have different degrees of vulnerability, different levels of fear — who goes to the top bunk?’’ Sapers says.

But CSC counters that it has and is taking significant steps to meet the “individual and specific needs’’ of aging inmates, through appropriate placement, equipment and care.

Among the steps taken, the agency points to cells designed to safely accommodate oxygen and respirator equipment.

“Where possible, aging offenders are grouped together. Every effort is made to place them near essential services in the institution and on the ground floor,’’ Veronique Rioux said in a statement.

CSC says its program supporting offenders’ end-of-life care offers those with non-curable, life-threatening ailments “compassionate, patient and family centred care in keeping with professionally accepted standards of practice.”

The offender can be provided palliative care in an institution, with the assistance of community support; in a CSC regional hospital, where nurses are available 24 hours a day; or in the community, Rioux says.

Jason Godin, national vice-president of the Union of Canadian Correctional Officers, says his members find that palliative cases are too spread out in prisons, which leads to “security issues for otherwise healthy inmates when resources need to be diverted to the ailing prisoners.’’

Godin suggests all the palliative cases be housed together in one unit in prisons as much as possible.

The capacity for geriatric and palliative care within Corrections Canada facilities is not equal to the needs, Sapers argues.

Among several recommendations Sapers has made to the correctional service is one calling for more staff with training and experience in palliative care and gerontology.

He has also recommended that where new construction is planned, “age-related physical and mental impairments should be part of the infrastructure design,’’ and plans and space for a sufficient number of accessible living arrangements should be included.

CSC points to other accommodation measures it has taken including step-stools to help get into and out of escort vehicles, and plumbing fixtures that are easier to manage. Disabled inmates, as well as older ones, benefit from these items.

Further improvements to infrastructure will be made, Rioux says.

In several minimum-, medium- and maximum-security facilities where new offender beds are slated, CSC is planning to build design features such as elevators for second-storey access; accessible kitchens, laundry, washrooms and showers; and ramps and sidewalks with curb cuts.

CSC couldn’t provide an exact dollar figure for the changes, but said they’re part of Ottawa’s five-year, $637-million capital expansion that began in 2010-2011 and will see 2,752 new cells for federal inmates. Of those, 100 will be accessible prison cells. CSC already has 355 accessible cells in five regions across the country.

Mary Campbell, a lawyer, expert on the correctional system and a retired director general with Public Safety Canada, says one of the biggest challenges is for older inmates who don’t have family outside prisons.

“So the question is where can you go?” Campbell said in a recent interview from Ottawa. “Halfway houses aren’t set up to provide palliative care. Seniors residences or long-term care have been iffy about taking people with a known criminal record.

“I’ve said to halfway house organizations that ‘you need to ramp up your game here and consider offering specialized services to elderly inmates,’ ’’ Campbell says.

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